Geropsychologist

Enter your Social Security Number in the space indicated. Providing your Social Security Number is voluntary, however we cannot process your application without it.

Vacancy Identification Number

729845

1. Title of Job

Geropsychologist

2. Biographic Data

3. E-Mail Address

Please enter your e-mail address in the space provided. If you do not provide an e-mail address you may not receive a notice of your results.

4. Work Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

5. Employment Availability

If you are applying by the OPM Form 1203-FX, leave this section blank.

6. Citizenship

Are you a citizen of the United States?

7. Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

8. Other Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

9. Languages

If you are applying by the OPM Form 1203-FX, leave this section blank.

10. Lowest Grade

Enter the lowest grade (11) you will accept for this position.

11

11. Miscellaneous Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

12. Special Knowledge

If you are applying by the OPM Form 1203-FX, leave this section blank.

13. Test Location

If you are applying by the OPM Form 1203-FX, leave this section blank.

14. Veteran Preference Claim

15. Dates of Active Duty - Military Service

16. Availability Date

If you are applying by the OPM Form 1203-FX, leave this section blank.

17. Service Computation Date

If you are applying by the OPM Form 1203-FX, leave this section blank.

18. Other Date Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

19. Job Preference

If you are applying by the OPM Form 1203-FX, leave this section blank.

20. Occupational Specialties

The specialty code(s) for this position is (are):001 Mental Health

21. Geographic Availability

The location code(s) for this position is (are):

082050101 Pueblo, CO

22. Transition Assistance Plan

23. Job Related Experience

If you are applying by the OPM Form 1203-FX, leave this section blank.

24. Personal Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

25. Occupational/Assessment Questions:

For each task in the following group, choose response below that best describes your experience and/or training.

1. Are you currently a permanent federal employee of the facility where the vacancy is located? (Please include a copy of your most recent Notification of Personnel Action, SF-50, that has items 24 and 34 completed.)

2. Are you currently a permanent federal employee of the Department of Veterans Affairs (VA)? (Please include a copy of your most recent Notification of Personnel Action, SF-50, that has Items 24 and 34 completed.)

3. If you are a current Federal employee, is your appointment in the Competitive or Excepted Service? (This is identified in Item 34 of your Notification of Personnel Action, SF-50.) (Please include a copy of your most recent Notification of Personnel Action, SF-50, that has Items 24 and 34 completed.)

A. My current appointment is in the Competitive Service. (SERVICE: COMPETITIVE)B. My current appointment is in the Excepted Service. (SERVICE: EXCEPTED)C. I am not a current Federal employee.

4. Are you eligible for appointment as a 30% or more compensably disabled Veteran? To be eligible, you must have retired from active military service with a service-connected disability rating of 30% or more, OR have a rating by the Department of Veterans Affairs showing a compensable service-connected disability of 30% or more. (Please include in your application Application for 10-Point Preference, SF-15, DD 214, and the documents required by the SF-15.)

A. YESB. NO

5. Are you an eligible Veteran? This means that you have an honorable or general discharge. (Please include in your application copies of your Certificate of Release or Discharge from Active Duty, DD-214.)

A. YESB. NO

The following sections include items related to the basic qualifications for this vacancy. Please respond to each question by selecting "Yes" or "No".

6. Do you possess a doctoral degree in psychology from a graduate program in psychology accredited by the American Psychological Association (APA). The specialty area of the degree must be consistent with the assignment for which the applicant is to be employed. AND Have successfully completed a professional psychology internship training program that has been accredited by APA. Exceptions: (1) new VHA psychology internship programs that are in the process of applying for APA accreditation are acceptable in fulfillment of the internship requirement, provided that such programs were sanctioned by the VHA Central Office Program Director for Psychology and the VHA Central Office of Academic Affiliations at the time that the individual was an intern and (2) VHA facilities who offered full one-year pre-doctoral internships prior to PL 96-151 (pre-1979) are considered to be acceptable in fulfillment of the internship requirement.

A. YesB. No

7. Do you hold a full, current, and unrestricted license to practice psychology at the doctoral level in a State, Territory, Commonwealth of the United States (e.g., Puerto Rico), or the District of Columbia. OR,

Exception. The Secretary may waive the requirement of licensure for an individual psychologist for a period not to exceed 2 years from the date of employment on the condition that such a psychologist provide care only under the supervision of a psychologist who is so licensed. Non-licensed psychologists who otherwise meet the eligibility requirements may be given a temporary appointment as

a graduate psychologist under the authority of 38 U.S.C. § 7405 (a) (1) (D). Failure to obtain licensure during that period is justification for termination of the temporary appointment. This may result in termination of employment.

A. YesB. No

The following items are related to the eligibility requirements for this vacancy. Please respond to each question by selecting "Yes" or "No".

8. Are you a U.S. Citizen?

A. YesB. No

9. Can you proficiently speak, read, write, and understand the English language?

A. YesB. No

10. Are you willing to undergo a comprehensive background investigation which includes, but is not limited to, contact with all references, employers, co-workers, personal associates, and review of your driving record, credit history, criminal history, and military service?

A. YesB. No

11. Applicants must undergo a pre-employment medical examination and be medically suitable to perform the essential duties of a Social Worker efficiently and without hazard to themselves and others. Are you willing to undergo a pre-employment medical examination?

A. YesB. No

The following is a Certification of Understanding. RESPONSE TO THIS STATEMENT IS MANDATORY. Please note, if you do not answer this question, it will result in not being considered for this position.

12. I certify that, to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C. 1001); my eligibilities may be cancelled; I may be denied an appointment; or I may be removed and debarred from Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated and that responding "No" or providing no response to this item will result in my not being considered for this position.

A. Yes, I certify that the information provided in this questionnaire is true, correct and provided in good faith, and I understand the information provided above.B. No, I do not certify the information provided above.

Resume Reminder - Your resume (and 10-2850c, Application for Associated Health Occupations) must include the following information for each job listed:Job title Duties (be as detailed as possible) Month & year start/end dates (e.g. June 2007 to April 2008)Full-time or part-time status (include hours worked per week)